CPT Webinar 5 Neuropsychological Testing ANTONIO E PUENTE

CPT Webinar #5: Neuropsychological Testing ANTONIO E. PUENTE UNIVERSITY OF NORTH CAROLINA WILMINGTON 09. 27. 15 5/22/2021 psychologycoding. com 1

Disclaimer The information contained in this extended presentation is not intended to reflect AMA, APA, CMS (Medicare), any division of APA, NAN, NAP, NCPA (or any state psychological association), state Medicaid and/or any private third party carrier policy. Further, this information is intended to be informative and does not supersede APA or state/provincial licensing boards’ ethical guidelines and/or local, state, provincial or national regulations and/or laws. Further, Local Coverage Determination and specific health care contracts supersede the information presented. The information contained herein is meant to provide practitioners as well as health care institutions (e. g. , insurance companies) involved in psychological services with the latest information available to the author regarding the issues addressed. This is a living document that can and will be revised as additional information becomes available. The ultimate responsibility of the validity, utility and application of the information contained herein lies with the individual and/or institution using this information and not with any supporting organization and/or the author of this presentation. Suggestions or changes should be directly addressed to the author. Note that whenever possible, references are provided. Finally, note that the CPT system is copyrighted and the information contained should be treated as such. CPT information is provided as a source of education to the readers of the materials contained. Thank you…aep 5/22/2021 psychologycoding. com 2

Acknowledgments: Organizations q North Carolina Psychological Association (NCPA) q American Psychological Association (APA) Practice Directorate (PD); Ethics Committee q American Medical Association (AMA) CPT Staff q National Academy of Neuropsychology (NAN) q Division of Clinical Neuropsychology of APA (40) q Center for Medicare & Medicaid Services (CMS) Medical Policy Staff- Medicare q National Academies of Practice (NAP) (presented in chronological order of engagement of support for the work outlined) 5/22/2021 psychologycoding. com 3

Acknowledgments: Individuals • AMA: Marie Mindenman, Tracy Gordy, Peter Hollman • APA: Randy Phelps, Norman Anderson, Katherine Nordal (APA Testing & Psychotherapy Groups) • NAN: PAIC Former and Present Committee • National Psychologist: Paula Hartman-Stein • Other: James Georgoulakis, Neil Pliskin, Pat De. Leon • 5/22/2021 (highly instrumental in recent CPT activities) psychologycoding. com 4

Support Provided 5/22/2021 psychologycoding. com 5

Personal Background (1988 – present) q North Carolina Psychological Association (e) q NAN’s Professional Affairs & Information Committee (a); Division 40 Practice Committee (a) q National Academy of Practice (e) q APA’s Policy & Planning Board; Div. 40; Committee for Psychological Tests & Assessments (e); Ethics Committee q Consultant with the North Carolina Medicaid Office; North Carolina Blue Cross/Blue Shield (a) q Health Care Finance Administration’s Working Group for Mental Health Policy (a) q Center for Medicare/Medicaid Services’ Medicare Coverage Advisory Committee (fa) q American Medical Association’s Current Procedural Terminology Committee Advisory Panel – HCPAC (IV/V) (a) q American Medical Association’s Current Procedural Terminology – Editorial Panel (e; rotating and permanent seat/second term) q Joint Committee for Standards for Educational and Psychological Tests (a) 5/22/2021 psychologycoding. com 6

Standards & Guidelines for the Practice of Psychology • • • APA Ethics Code (2002) HIPAA and other federal regulations State or Province License Regulations Contractual Agreements with Third Parties Professional Standards (e. g. , Standards for Educational and Psychological Tests, 1999; in revision) 5/22/2021 psychologycoding. com 7

Medicare: Local Review • Medical Review Policy – National Policy Sets Overall Model – Local Coverage Determination (LCD) Sets Local/Regional Policy • • • 5/22/2021 More restrictive than national policy Over-rides national policy Changes frequently without warning or publicity Applies to Medicare and private payers Information best found on respective web pages psychologycoding. com 8

CPT: Copyright • CPT is Copyrighted by the American Medical Association • CPT Manuals May be Ordered from the AMA at 1. 800. 621. 8335 • www. ama-assn. org/go/cpt 5/22/2021 psychologycoding. com 9

CPT: CNS Assessment Codes Timetable: An Example of Time from Idea to Reality • Activity x Date – – – – – – – Codes Without Cognitive Work Obtained, 1994 Ongoing Discussions with CMS About Lack of Work Value, 1995 -2000 Request by CMS/AMA to Obtain Work Value, approximately 2000 Initial Request for Practice Expense by APA, Summer, 2002 APA Appeared Before AMA RUC, September, 2003 Initial Decision by AMA CPT Panel, November 7, 2004 Call for Other Societies to Participate, November 19, 2004 Final Decision by AMA CPT Panel, December 1, 2004 Submission of CPT Codes to AMA RUC Committee immediately thereafter Review by AMA RUC Research Subcommittee in January, 2005 Review by AMA RUC Panel in February 3 -6, 2005 Survey of Codes, second & third week of February, 2005 Analysis of Surveys, March, 2005 Presentation to RUC Committee in April, 2005 Inclusion in the 2006 Physician Fee Schedule on January 1, 2006 Meeting with CMS, April 24, 2006 CMS Transmittal and NCCI Edits published September, 2006 AMA CPT Assistant articles published November, 2006 AMA CPT Assistant Q & A published December, 2007 Presentation to AMA CPT Panel February 9, 2007 Presentation to CMS a series of Q and As July, 2007 Acceptance and publication of new CPT testing code language, October, 2008 Initial acceptance of clarification of testing codes by CMS, October, 2008 Continued involvement in the explanation of their use (e. g. , AMA CPT presentation, October, 2010) Working on compliance officers interpretation of simultaneous use of professional and technical codes Now working a new code for interpretation For more information: www. ama-assn. org/go/cpt-processfaq 5/22/2021 psychologycoding. com 10

CPT: Applicable Codes • Total Possible Codes = Approximately 8, 000 • Possible Codes for Psychology = Approximately 70 • Sections = Five Primary Separate Sections – Psychiatry (e. g. , mental health) undergoing study & possible revision – Biofeedback – Central Nervous System Assessment (testing) – Physical Medicine & Rehabilitation – Health & Behavior Assessment & Management – Team Conference – Evaluation and Management – Applied Behavior Analysis (Category 3) 5/22/2021 psychologycoding. com 11

Three Types of Codes • • Psychiatric/Mental Health (1970 s? ) Neuropsychological (added in 1990 s) Health and Behavior (2000 s) Miscellaneous – Preventative – Evaluation & Management (E & M) – Telehealth – Applied Behavior Analysis 5/22/2021 psychologycoding. com 12

Neuropsychological (and psychological testing) • Psychiatric • Health and Behavior 5/22/2021 psychologycoding. com 13

CNS Assessment Codes : Rationale for Changes of Testing Codes • Avoidance of Continuation of Reimbursement Heavily Based on Practice Expense • Greater Clarification of Activities Including Interviewing and Testing by Professional, Technician and/or Computer • Recognition of Cognitive Work • Great Clarity of What Actual is Happening • Differentiation of Professional, Technical and (nonassisted) Computer Testing • Most Importantly, a Mandate from CMS • Testing Codes Available for Use by Physicians and Psychologists Only (includes neuropsychologists) 5/22/2021 psychologycoding. com 14

CPT: CNS Assessment CPT Assistant, 03. 06; CPT Assistant, 11. 06, 12. 06 • Psychological Testing (e. g. , 5 units) – Three New Codes – New Numbers & Descriptors • Neurobehavioral Status Exam (e. g. , 2 units) – New Number & Revised Descriptor • Neuropsychological Testing (e. g. , 10 units) – Three New Codes – New Numbers & Descriptors 5/22/2021 psychologycoding. com 15

Testing Information • Federal Register, November 21, 2005 at 70 FR 70279 and 70280 under Table 29 and CPT HCPAC Recommendations and CMS Decisions for New and Revised 2006 CPT Codes • MLN Matters Number: MM 5204 5/22/2021 psychologycoding. com 16

Reporting Testing Codes • A minimum of 31 minutes must be provided to report any per hour code. Services 96101, 96105, 96116, 96118 and 96125 report time as face-to-face time with the patient and the time spent interpreting and preparing the report. (CPT Changes: An insider’s view, 2011) 5/22/2021 psychologycoding. com 17

Neurobehavioral Status Exam (01. 06; Revised 02. 09. 07; Implemented 01. 08) • 96116 - Neurobehavioral status exam – Clinical assessment of thinking, reasoning and judgment ( e. g. , acquired knowledge, attention, language, memory, planning and problem solving, and visual-spatial abilities) per hour of psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report 5/22/2021 psychologycoding. com 18

96116 Explained (CPT Assistant, November, 2006) • “A neurobehavioral status exam is completed prior to the administration of neuropsychological testing. The status exam involves clinical assessment of the patient, collateral interviews (as appropriate and review of prior records. The interview would involved clinical assessment of several domains including but limited to; thinking, reasoning and judgment, e. g. , acquired knowledge, attention, language, memory, planning and problem solving and visual spatial abilities. The clinical assessment would determine the types of tests and how those tests should be administered. ” 5/22/2021 psychologycoding. com 19

Neuropsychological Testing: By Professional (Revised 02. 09. 07; Implemented 01. 08) (revisions in italic and underlined) • 96118 – Neuropsychological Testing – (e. g. , Halstead-Reitan Neuropsychological, WMS, Wisconsin Card Sorting) per hour of psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report (96118 is also used in those circumstances when additional time is necessary to integrate other sources of clinical data, including previously completed and reported technicianand computer-administered tests. ) (Do not report 96118 for the interpretation and report of 96119 or 96120. ) 5/22/2021 psychologycoding. com 20

96118 Explained (CPT Assistant, November, 2006) • Code 96118 is reported for the neuropsychological test administration by the physician or psychologist with subsequent interpretation and report by the physician, or psychologist. It is also reported for the integration of information obtained from other sources which is then incorporated in the more comprehensive interpretation of the meaning the tests results in the context of all testing and assessments. The administration of the tests is completed for the purposes of a physical health diagnosis. ” 5/22/2021 psychologycoding. com 21

96118 Applications • Administration of Neuropsychological Tests • Scoring of Neuropsychological Tests • Integration of Those Tests and Other Information Including but not Limited to: – Interview (direct and collateral) – Behavior – History • Feedback to the Patient and Integration of Those Findings in the Final Report (not to be used as apsychologycoding. com treatment basedcode) 5/22/2021 22

Neuropsychological Testing: By Technician (01. 06) • 96119 - Neuropsychological testing – (e. g. , Halstead-Reitan Neuropsychological, WMS, Wisconsin Card Sorting) with qualified health care professional interpretation and report, administered by a technician per hour of technician time, face-to-face 5/22/2021 psychologycoding. com 23

96119 Explained (CPT Assistant, November, 2006) • “The qualified health professional has previously gather information from the patient about the nature of the complaint and the history of the presenting problems. Based on the clinical history, a final selection of tests to be administered is made. The procedures are explained to the patient, and the patient is introduced to the technicians, which administers the tests. During testing, the qualified health professional frequently checks with the technician to monitors the patient’s performance and make any necessary modifications to the test battery or assessment plan. When all tests have been administered, the qualified health professional meets with the patient again to answer any questions. ” 5/22/2021 psychologycoding. com 24

Neuropsychological Testing. By Computer (01. 06) • 96120 - Neuropsychological testing – (e. g. , WCST) administered by a computer with qualified health care professional interpretation and the report 5/22/2021 psychologycoding. com 25

96120 Explained (CPT Assistant, November, 2006) • “Code 96120 is reported for the computer-administrated neuropsychological testing, with subsequent interpretation and report of the specific tests by the physician, psychologist, or other qualified health care professional. This should be reserved for situations where the computerized testing is unassisted by a provider or technician other than the installation of programs/test and checking to be sure that the patient is able to complete the tests. If grater levels of interaction are required, though the test may be computerized administer, then the appropriate physician/psychologist (96118) or technician code (96119) should be used. ” 5/22/2021 psychologycoding. com 26

Computerized Testing • Not time based • Used once per “testing session” • To be used for one to multiple tests only once per “testing session” • CPT Assistant, October 2011, Vol. 21, #10, pg. 10). 5/22/2021 psychologycoding. com 27

Computerized Testing: Use by Physicians • 96103 – Neurologists = 27% – Family Physicians/Internal Medicine = 22% • 96120 – Neurologists = 47 % 5/22/2021 psychologycoding. com 28

Coding Tip (CPT Assistant, November, 2006) • “If the service is provided is less than one hour, append Modifier 52, Reduced Services. After one hour has been completed, time is rounded. ” • “It is not unusual that the assessments may include testing by a technician and a computer with interpretation and report by the physician, psychologist or qualified health professional. Therefore, it is appropriate in such cases to report all 3 codes in the family of 96101 -96103 or 96118 -96120. ” 5/22/2021 psychologycoding. com 29

Coding Tip (CPT Assistant, November, 2006) • “All of the testing and assessment services also require interpretation in the context of other clinical assessments performed by a qualified professional as well as prior records. The use of the term “interpretation” in these codes is this integrative process. It is not the scoring or interpretation of the result of a specified tests or tests. The scoring process and more limited interpretation is part of the test administration services whether by physician/psychologist, technician and/or computer. ” 5/22/2021 psychologycoding. com 30

Code Usage (CPT Assistant, November, 2006) • “Typically, the psychological testing services, 96101 -96103 -, the neurobehavioral status exam, 96116, and the neuropsychological testing services, 96118 -96120, are administered once per illness condition or when a significant change in behavior and/or medical/health condition necessitates re-evaluation. ” 5/22/2021 psychologycoding. com 31

Additional Supporting Information • • • CMS Manual Pub 100 -02 Medicare Benefit Policy Change Request 5204 Transmittal 85 February 25, 2008 • (reference Transmittal 55; Change Request 5204; September 29, 2006) 5/22/2021 psychologycoding. com 32

Screening Testing Code (Effective 01. 15) • 96127 • Brief emotional/behavioral assessment (e. g, depression inventory, attentiondeficit, hyperactivity disorder (ADHD) scale, with scoring and documentation, per standardized instrument (CPT Insider’s Guide: 2015) 5/22/2021 psychologycoding. com 33

Testing Citations in CPT Assistant • Jun 14. Volume 24, Issue 6, June 2014 • Oct 11. Volume 21, Issue 10, October 2011 • Sep 10. Volume 20, Issue 9, September 2010 5/22/2021 psychologycoding. com 34

Code Frequency Use Code 2006 2007 2008 96116 102, 387 108, 470 109, 014 96118 387, 813 416, 887 460, 327 96119 95, 341 89, 640 96, 151 5/22/2021 psychologycoding. com 35

Code Information Code Locale Over 75 Specialty Dx 96116 Opt. Office 64% CP PPD/Dement. 96618 Opt. Office 55% CP PPD/Dement. 96619 Opt. Office 46% CP PPD/Dement. 5/22/2021 psychologycoding. com 36

Medicare National Payments (2014 -15) Code Payment 96116 94. 93 96118 99. 24 96119 81. 32 96120 48. 02 5/22/2021 psychologycoding. com 37

Tests Performed by Technicians & Computers • Effective January 1, 2006, CPT Codes for psychological and neuropsychological tests performed by technicians and computers (CPT codes 96102, 96103, 96119 and 96120) in addition to tests performed by physicians, clinical psychologists, independently qualified practicing psychologists and other qualified non-physician practitioners. ID 9176, Created 06/17/2008, 11: 21 am; Last updated 06/09/2009 01: 41 PM 5/22/2021 psychologycoding. com 38

Simultaneous Use of Professional and Technical Codes • Currently Allowed by Medicare – MLN Matters: MM 5204 Revised, Effective December 28, 2006 – http: //www. cms. gov/Outreach-and. Education/Medicare-Learning-Network. MLN/MLNMatters. Articles/downloads/mm 5204. pdf – Most conservative; modifier 59 and one test by professional 5/22/2021 psychologycoding. com 39

Psychological & Neuropsychological Testing Codes: Use of Professional and Technical/Computer Codes • Local Carrier Policy Trumps National Policy • Possibilities Include – No simultaneous use of prof. & technical codes – No problem in using both prof. & technical codes – Alternatives (e. g. , modifier 59) • The Use of Modifier 59 5/22/2021 – When professional codes and technical/computer codes are used simultaneously 40 – The modifier ispsychologycoding. com used with the non-professional code

Simultaneous Use of Testing Codes 1. When the provider administers at least one of the tests, then pre-existing problems with the simultaneous use of two testing codes do not apply (Niles Rosen, M. D. , NCCI, Personal Communication, November, 2009; Regina Walker-Wren, CMS, 06. 03. 13, memo) 2. When the professional and the technical services are not provided on the same date. 5/22/2021 psychologycoding. com 41

Simultaneous Codes: NCCI (AMA Code Manager, 2009; Section M) • “Two or more codes may be reported on the same date of service if and only if the different testing techniques are utilized for different neuropsychological tests” 5/22/2021 psychologycoding. com 42

Simultaneous Codes: NCCI • 96118 and 96119 (as well as 96101 and 96102) can be reported on the same day if the professional “personally administers at least one test to the patient” Niles Rosen, M. D. , NCCI, 08. 28. 13 5/22/2021 psychologycoding. com 43

Simultaneous Codes: NCCI • “The NCCI edits applies to services performed on the same date of service for the same beneficiary by the same provider. However, CMS is very much aware and concerned about providers who avoid NCCI edits and coding rules by unnecessarily performing two services n two different dates of services that would not be separately payable if they had been performed on the same date of service. ” Niles Rosen, M. D. , NCCI, 08. 28. 13 5/22/2021 psychologycoding. com 44

Possible Origin to Problems with Simultaneous Use of Testing Codes • www. gao/newitems/d 09647. pdf • When service are provided together, empirical evidence suggests increased efficiency but increased costs • 95% reduction to 75% suggests increased savings to Medicare but not objective utilization • 600 Services have been identified as high volume growth and/or performed together 5/22/2021 psychologycoding. com 45

Potential Problems with Simultaneous Use of Test Codes • Some insurance companies may be excluding the use of professional and technical codes simultaneously • Ingenix, Mc. Kessons other computerized edit systems, may be disallowing simultaneous test codes • Compliance officers at large institutions 5/22/2021 psychologycoding. com 46

Modifier 59 & Testing Codes • Modifier is not applicable if the professional provides the service. • If the technician provides the service, it is advisable (pending MAC guidelines) to use the 59 modifier. • The modifier should be applied to any of the testing codes though probably best to attach to technician and/or computer codes (CMS, September, 2006) 5/22/2021 psychologycoding. com 47

Official Q & As from CMS Regarding Testing Codes • Probably will not be further revised and additional concerns will be handled at the local carrier level • http: //www. cms. gov/Outreach-and. Education/Medicare-Learning-Network. MLN/MLNMatters. Articles/downloads/mm 5 204. pdf 5/22/2021 psychologycoding. com 48

Take Away Message on the Use of Two or More Testing Codes • Bill for techs what techs do, period. • Bill for professionals what professionals do, period (this includes “integrate separate interpretations into a comprehensive report” • You CAN bill for both sets of codes together. 5/22/2021 psychologycoding. com 49

Two Codes Summary • If two testing codes are to be used on the same day, professional should perform (and document) the administration, score and interpret one test. • Alternatively, one activity (code) should be done on one day and another (code) the other day 5/22/2021 psychologycoding. com 50

Documentation for Two or More Testing Codes • 11. 01. 11 • To: Schafer, Jyme H. (CMS/OCSQ); Syrek Jensen, Tamara S. (CMS/OCSQ); Daily, Karen A. (CMS/OCSQ); Pedulla, Diane • Cc: Ritter, Christina S. (CMS/CMM); Hambrick, Edith L. (CMS/CMM) • From: Regina Walker Wren Health Insurance Specialist CMS 5/22/2021 psychologycoding. com 51

Problems Left With Use of Two or More Testing Codes • CPT Code Audit Systems (Mc. Kessons) • Insurance Carriers, such as WPS and Trailblazers, are in agreement 5/22/2021 psychologycoding. com 52

Simultaneous Use of 90781 and 96116 • Under No Circumstances are the Psychiatric (90791) and Neurobehavioral Status Examination (96116) are to be Used Simultaneously 5/22/2021 psychologycoding. com 53

CNS Assessment Examples • Neurobehavioral Status with Neuropsychological Testing – Interview by the Professional – Testing by • Professional, and/or • Technician, and/or • Computer. – Interpretation & Report Writing by Professional – A Technician or Computer Code are “Typically” Billed Together with a Professional Code Assuming that Different Services are Being Provided (since the final product should be a comprehensive/integrative report) 5/22/2021 psychologycoding. com 54

Testing & HCPC Codes • Possibility exists of charging for “expensive” test forms using HCPC codes 5/22/2021 psychologycoding. com 55

New Cognitive Testing Code for Use by OT, ST and Others • 96125 – Standardized Cognitive Performance Testing – (e. g. , Ross Information Processing Assessment). – (For psychological and neuropsychological testing by a physician or psychologist, see 96101 -96103 - 96118 -96120) 5/22/2021 psychologycoding. com 56

Telehealth Services • • • Individual Psychotherapy Psychiatric Diagnostic Interviewing All Health and Behavior Codes Neurobehavioral Status Exam Presently discussing Testing Services 5/22/2021 psychologycoding. com 57

Value Based Modifier • Phased in by 2017 • Roll out in 2015 to 100 physician specialties • By 2017 to groups of 10 or more physicians • Related to PQRS • Assesses both care furnished & cost of that care • Focuses on quality and outcome 5/22/2021 psychologycoding. com 58

Value Based Modifier (MLN Connects, 11. 13. 14) • • • Cost Measure Attribution Quality Tiering Approach Performance on Quality Composite Performance of Cost Composite Outcome – Focus on chronic conditions (e. g. , diabetes) – Approximately 8% will increase and 10% will decrease payment 5/22/2021 psychologycoding. com 59

Diagnosing • Limited Formulary Often Offered by Third Parties • Multiple Diagnoses May be of Value • Psychiatric – DSM • The problem with DSM and neuropsych testing of developmentallyrelated neurological problems • Neurological & Non-Neurological Medical – ICD – 9 CM (physical diagnosis coding) – www. cdc. gov/nchs/about/otheract/icd 9 – www. eicd. com/eicd. main. htm (Note: Always consult LCD information to determine formulary) 5/22/2021 psychologycoding. com 60

Diagnosing (cont. ) • Billing Diagnosis – Based on the referral question – What was pursued as a function of the evaluation • Clinical Diagnosis – What was concluded based on the results of the evaluation – May not be the same as the billing or original working diagnosis 5/22/2021 psychologycoding. com 61

International Classification of Diseases • Present – ICD-9 -CM (Clinical Modification) – Since 1978 • Future – ICD-10 -CM (Clinical Modification) – ICD-10 -PCS (Inpatient Procedures) – Start date – October 21, 2015 5/22/2021 psychologycoding. com 62

Simple Explanation of Medical Necessity and Eventual Coverage Existence of Evidence for Therapeutic Decision Making (will it make a difference? ) 5/22/2021 psychologycoding. com 63

Documentation: Assessment • • • Identifying Information Reason for Service Dates Time (amount of service time; total Vs. actual) Identity of Tester (technician? ) Tests and Protocols (included editions) Narrative of Results Impression(s) or Diagnosis(es) Disposition 5/22/2021 psychologycoding. com 64

Documentation: “Assessment” Based on New Interpretation of Codes • Technical Component – Label • Testing by Technician – Information • Individual Tests • Numerical • Basic Qualitative • Professional Component – Label • Examples; Integration of Findings, Testing by Professional – Interpretation • Integration of findings which may include history, prior records, interview(s), and compilation of tests 5/22/2021 psychologycoding. com 65

Technician: Definition Federal Register, Vol. 66, #149, page 40382 • Requirement – Employee (e. g. , 1099); “employees, leased employees, or independent contractor” – Most common is independent contractor – “We do not believe that the nature of the employment relationship is critical for purposes of payment to the services of physician…as long as…(the personnel) is under the required level of supervision. ” • Common Practice – Independent Contractor – In Institutional Settings – institutional contract (source- NAP) 5/22/2021 psychologycoding. com 66

Technician: NAN’s Definition • Approved by NAN Board of Directors – 08. 2006 • Archives of Clinical Neuropsychology– 2006 (e. g. , Puente, et al) 5/22/2021 psychologycoding. com 67

Technicians: Application • Practice Expense & Practice Implications – Each tech code has. 51 work value – This means that the professional is engaged in the work, namely, supervision (and interpretation) – That supervision would include; • • • 5/22/2021 Selection of tests Determination of testing protocol Supervision of testing Interpretation of individual tests Reporting on individual tests Assisting with concerns raised by the patient psychologycoding. com 68

Technicians: Interfacing with Professionals • The Qualified Health Provider must; – See the patient first – Supervise the activity – Interpret and write the note/report – Engaged in an ongoing capacity NOTE: Pattern similar to medical and other health providers 5/22/2021 psychologycoding. com 69

Students as Technicians • Medicare Interpretation – Medicare has never reimbursed for student training for any health disciplines – The assumption is that GME pays training programs and double dipping would occur if the Medicare and the CPT reimbursed for student activity – Two caveats: • This limitation probably applies to Medicare only • Students can perform as technicians as long as they are not being trained and their activity is not part of their educational requirements (e. g. , a neuropsychologist in the community employees the student as a technician in their practice) 5/22/2021 psychologycoding. com 70

Supervision Program Memorandum Carriers Department of Health and Human Services- HCFA Transmittal b-01 -28; April 19, 2001 • Levels of Supervision – General • Furnished under overall direction and control, presence is not required – Direct • Must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure – Personal • Must be in attendance in the room during the performance of the procedure 5/22/2021 psychologycoding. com 71

96616 RVU 96116 Facility Non-Facility Work 1. 86 Expense 0. 47 0. 61 Mal Pract 0. 18 Total 2. 51 2. 65 5/22/2021 psychologycoding. com 72

96118 RVU 96118 Facility Non-Facility Work 1. 86 Expense 0. 41 0. 96 Mal Pract 0. 18 Total 2. 45 3. 00 5/22/2021 psychologycoding. com 73

96119 RVU 96619 Facility Non-Facility Work 0. 55 Expense 0. 13 1. 33 Mal Pract 0. 18 Total 0. 86 2. 06 5/22/2021 psychologycoding. com 74

Misvalued Services • Medicare Payment Advisory Commission (Med. Pac) • Each code will be undergo a Five Year review Identification Workgroup analysis 5/22/2021 psychologycoding. com 75

PQRS Measures • • • Measure #280 – Staging of Dementia Measure #281 – Cognitive Assessment Measure #282 – Functional Status Assessment Measure #283 – Neuropsychiatric Symptom Assessment Measure #284 – Management of Neuropsychiatric Symptoms Measure #285 – Screening for Depressive Symptoms Measure #286 – Counseling Regarding Safety Concerns Measure #287 – Counseling Regarding Risks of Driving Measure #288 – Caregiver Education and Support 5/22/2021 psychologycoding. com 76

Staging of Dementia Measure #280 Numerator QDC 5/22/2021 Staging of Dementia Patients whose severity of dementia was classified as mild, moderate or severe at least once within a 12 month period. Dementia severity can be assessed using one of a number of available valid and reliable instruments available from the medical literature, including formal neuropsychological assessment. CPT II 1490 F Dementia severity classified, mild CPT II 1491 F Dementia severity classified, moderate CPT II 1493 F Dementia severity classified, severe 1490 F with 8 P Dementia severity not classified, reason not otherwise psychologycoding. com specified 77

The Future of CPT • Applied Behavior Analysis (2014) • PQRS (add on) (2014? ) • Expanded Evaluation & Management– Prolonged Service (2014) • Revaluing of H & B Codes (2015) • Re-doing Testing Codes(2015) • Integrative Healthcare codes (2015) • Prevention or G Codes (2016? ) 5/22/2021 psychologycoding. com 78

Health Care Bill: How Health Care Will Be Revolutionized by 2018 Bill: http: //thomas. loc. gov/cgibin/bdquery/z? d 111: H. R. 4872: Timetable: http: //www. commonwealthfund. org/Content/ Publications/Other/2010/Timeline-for. Health-Care-Reform. Implementation. aspx#2010 (also, www. healthcare. gov) 5/22/2021 psychologycoding. com 79

ACA & Misvalued Service (from K. Bryant, AMC CPT Symposium 11. 2013) • • The Affordable Care Act requires an examination of potentially misvalued codes in seven categories: 1. Codes and families of codes for which there has been the fastest growth, 2. Codes and families of codes that have experienced substantial changes in practice expenses, 3. Codes that are recently established for new technologies or services, 4. Multiple codes that are frequently billed in conjunction with furnishing a single service, 5. Codes with low relative values, esp. those that are billed multiple times for a single service, 6. Codes which have not been reviewed since the implementation of the RBRVS (the so-called “Harvard-valued codes”), 7. Other codes to be determined by the Secretary. 5/22/2021 psychologycoding. com 80

Final Summary • Negative News – Decrease in Reimbursement Using Traditional Approaches (about 2%) – Transparency & Accountability (negative? ) • Positive News – – – Transparency & Accountability Much Wider Scope of Practice Larger Number of Patients Newer Paradigms (telehealth; team & coordinated care) Increase in Professionalism Mainstream Integrated Health Care (Vs. Silo/Isolated) 5/22/2021 psychologycoding. com 81

Tsunami of a Change • Expected to Change – Reimbursement System – National Heath Care Policy – Diagnostic System • Timetable of Change – New Codes next 5 years – New System thereafter 5/22/2021 psychologycoding. com 82

More Information • www. psychologycoding. com • Release of revised ICD-10 workshop notes on 09. 30. 15 • Next presentation will be on 10. 26. 15 – Updates on ICD-10 – Alternative healthcare models (e. g. , ACA interpretation at state levels, etc. ) 5/22/2021 psychologycoding. com 83

Resources • General Web Sites – www. ama-assn. org/go/cpt (cpt) – www. apa. org (general apa website) – www. apapracticecentral. org (resources for practicing psychologists) – www. nanonline. org/paio (practice patterns & information) – www. apa. org/practice/cpt (apa’s cpt information) – www. cms. org (medicare/medicaid) – www. hhs. org (health & human services) – www. oig. hhs. gov (inspector general) – www. ahrq. gov (agency for healthcare research) – www. medpac. gov (medical payment advisory comm. ) – www. whitehouse. gov/fsbr/health (statistics) – www. div 40. org (clinical neuropsychology div of apa) – www. napnet. org (national association of psychometrists) – www. psychometristscertification. org (board of certified psychometrists) – www. access. gpo. gov (federal statutes and regulations) – www. healthcare. group. com (staff salaries) – www. commonweath. com (health care policy) 5/22/2021 psychologycoding. com 84

Resources (continued) • Payment/Coverage – – – – • • LMRP Reconsideration Process – www. cms. gov/manuals/pm_trans/R 28 PIM. pdf PQRS – • www. myhealthscore. com/consumer/phyoutcptsearch. htm www. cms. hhs. gov/statistics/feeforservice/defailt. asp (covered services) www. cms. hhs. gov/mcd/viewtrackingsheet. asp? id=167 (non-covered) www. apa. org/pi/aging/lmrp/toolkit/homepage. html (apa lcd) www. cms. hhs. gov/providers/mr/lmrp/asp (medicare lmrp) www. quickfacts. census. gov/qfd (census x type of procedure data) www. usqualitymeasures. org (payment for performance) www. centerforhealthyaging. com Compliance Web Sites – www. oig. hhs. gov (office of inspector general) – www. cms. hhs. gov/manuals (medicare) – www. uscode. house. gov/usc. htm (united states codes) – www. apa. org (psychologists & hipaa) – www. cms. hhs. gov/hipaa. (hipaa) – www. hcca-info. org (health care compliance assoc. ) – www. cms. gov/oas/cms. asp 5/22/2021 psychologycoding. com 85

Resources (continued) • ICD – www. who. int/icd/vol 1 htm 2003/fr-icd. htm (who) – www. cdc. gov/nchas/about/otheract/icd 9/abticd 9. htm (ccd) • PQRS – www. centerforhealthyaging. com • Coding Web Sites – www. catalog. amaassn. org/Catalog/cpt_search. jsp (ama cpt) – www. aapcnatl. org (academy of coders) – www. ntis. gov/product/correct-coding (coding edits) 5/22/2021 psychologycoding. com 86

Additional Sample Forms • Office Forms – CPT Routing – PQRS • Clinical Forms – Psychiatric Interviewing – Psychotherapy – Neurobehavioral Status Exam – Neuropsychological Testing (prof & technical) 5/22/2021 psychologycoding. com 87

AMA Contact Information • Website – www. amabookstore. com – Link to; • catalog. ama-assn. org/Catalog/cpt/issue_search. jsp • Telephone – 312. 464. 5116 5/22/2021 psychologycoding. com 88

APA Contact Information • American Psychological Association - Katherine Nordal, Ph. D. Practice Directorate, Director American Psychological Association 750 First Street, N. W. Washington, D. C. 20002 • Association for the Advancement of Psychology – www. aapnet. org – P. O. Box 38129 – Colorado Springs, Colorado 38129 5/22/2021 psychologycoding. com 89

Puente Contact Information • Websites – – Coding= Univ = Practice = Vita/Academic= www. psychologycoding. com www. uncw. edu/people/puente www. clinicalneuropsychology. us www. antonioepuente. com • E-mail – University = – Practice = puente@uncw. edu clinicalneuropsychology@gmail. com • Telephone – University = – Practice = 5/22/2021 910. 962. 3812 910. 509. 9371 psychologycoding. com 90